Treating Deconditioning in Older Adults

Especially in older adults, deconditioning is a significant factor in physical outcomes.

As the saying goes, “use it or lose it.”

Especially in older adults, deconditioning is a significant factor in physical outcomes. Researchers have noted that older patients tend to have low levels of engagement in exercise, particularly after a hospital discharge. Physical therapists who work with this population should design exercise programs to address barriers, engage facilitators, and enhance motivation for older adults.

Recommended course: Exercise Prescription Management of the Older Adult: An Evidence-Based Approach, 2nd Edition

Treating deconditioning with exercise

Therapists and researchers have found that aerobic exercise improved aerobic fitness and decreased depressive symptoms in their clients. Reduction in depressive symptoms may result from physical and/or behavioral mechanisms associated with aerobic exercise.

In a randomized controlled study examining progressive resistance training in depressed older adults, experts found that progressive resistive training is an effective antidepressant in depressed elders, while also improving strength, morale, and quality of life.

A study found that walking more than four hours per week may significantly reduce the risk of hospitalization for cardiovascular disease and reduce risk of death when adjusted for age and sex.

Practical interventions

When addressing deconditioning in older adults, therapists must first accurately assess their client’s strength levels. Stretch muscles that are tight, those that restrict mobility, and any that show weakness.

Therapists need to get older clients up as quickly as possible, while at the same time showing care not to overload them. It’s generally more beneficial for clients to do several smaller sessions within their heart rate range than one long session that pushes them above a safe heart rate limit.

The best way to determine the appropriate heart rate range is to use a heart rate formula.

Find helpful charts here.

Having older patients work out for three short sessions per day for 10 minutes in their heart rate range has been shown to be of the most benefit.

Finally, remember that reconditioning takes twice as long as deconditioning. Physical therapists need to inform clients that if it has taken them three months to get to this low level, it will take them six months of diligent work to get back to their prior level of function and conditioned status.

Guidelines for therapists treating deconditioning in older adults

Guidelines for physical activity for community-dwelling older adults are readily available online, including in the Journal of American Family Physician.

Minimum activity for achieving important health benefits includes:

• Two hours and 30 minutes (150 minutes) of moderate-intensity aerobic activity (e.g., brisk walking) per week, plus muscle-strengthening activities on at least two days of the week; or
• One hour and 15 minutes (75 minutes) of vigorous-intensity aerobic activity (e.g., jogging, running) per week, plus muscle-strengthening activities on at least two days of the week; or
• A combination of moderate- and vigorous-intensity aerobic activity equivalent to the recommendations above, plus muscle-strengthening activities on at least two days of the week.

Increased activity for achieving additional health benefits includes:

• Five hours (300 minutes) of moderate-intensity aerobic activity per week, plus muscle-strengthening activities on at least two days of the week; or
• Two hours and 30 minutes (150 minutes) of vigorous-intensity aerobic activity per week, plus muscle-strengthening activities on at least two days a week; or
• A combination of moderate- and vigorous-intensity aerobic activity equivalent to the recommendations above, plus muscle-strengthening activities on at least two days of the week.
• Activity level should be relative to physical ability, and exercises to improve balance and flexibility may also be beneficial. Aerobic activity should occur throughout the week, with each session lasting at least 10 minutes. Muscle-strengthening activities should work all major muscle groups (legs, hips, back, abdomen, chest, shoulders and arms), and consist of eight to 12 repetitions per activity, or should continue until it would be difficult to do another repetition without help.

Explore the CDC's physical activity guidelines for older adults here.

Interventions for older adults living in skilled nursing facilities

For clients living in skilled nursing facilities, there are several simple and easy ways to work on deconditioning, including a specific nursing intervention called the FIT intervention.

The FIT intervention requires six minutes more nursing time, but it improves mobility and physical activity in patients who are deconditioned. While the nurses work with patients on continence care, they also complete the following:

1. Assist patients in practicing sit-to-stand to fatigue
2. Lead each patient in progressive resistive exercise to all large joints, using weights
3. Encourage and help the patient to walk or propel a wheelchair for five to 20 minutes

This program would be a wonderful adjunct to a traditional physical therapy program.

A multidisciplinary approach to treating deconditioning

To gain the best outcomes for clients, therapists must work in conjunction with nurses and other rehabilitation professionals to design and implement effective treatment programs for deconditioned older adults.